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Frailty Predicts Medical Complications, Length of Stay, Readmission, and Mortality in Revision Hip and Knee Arthroplasty.
J Arthroplasty. 2019 Jul; 34(7):1412-1416.JA

Abstract

BACKGROUND

The purpose of this study is to evaluate the 5-factor modified frailty index (mFI-5) as a predictor of postoperative complications, readmission, and mortality in patients undergoing revision hip and knee arthroplasty.

METHODS

A retrospective analysis of the American College of Surgeon's National Surgical Quality Improvement Program's database for patients undergoing revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) between the years 2005 and 2016 was conducted. The 5-factor score, which includes presence of comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and postoperative complications while controlling for demographic variables.

RESULTS

In total, 13,948 patients undergoing rTHA and 16,304 patients undergoing rTKA were identified. The mFI-5 was a strong predictor of serious medical complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), discharge to a facility, total length of stay, readmission, and mortality (P ≤ .007).

CONCLUSION

The mFI-5 predicts serious medical complications, increased length of stay, discharge to a facility, hospital readmission, and mortality in patients undergoing rTHA and rTKA. All the variables within the mFI-5 are easily obtained through the patient history, allowing for a practical clinical tool that hospitals and physicians can use to identify at-risk patients, educate and engage patients and their families in a shared decision-making conversation, and guide perioperative care in order to optimize patient outcomes.

LEVEL OF EVIDENCE

III.

Authors+Show Affiliations

Department of Orthopaedics, Medical University of South Carolina, Charleston, SC.Department of Orthopaedics, Medical University of South Carolina, Charleston, SC.Department of Orthopaedics, Medical University of South Carolina, Charleston, SC.Department of Orthopaedics, Medical University of South Carolina, Charleston, SC.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30930155

Citation

Traven, Sophia A., et al. "Frailty Predicts Medical Complications, Length of Stay, Readmission, and Mortality in Revision Hip and Knee Arthroplasty." The Journal of Arthroplasty, vol. 34, no. 7, 2019, pp. 1412-1416.
Traven SA, Reeves RA, Slone HS, et al. Frailty Predicts Medical Complications, Length of Stay, Readmission, and Mortality in Revision Hip and Knee Arthroplasty. J Arthroplasty. 2019;34(7):1412-1416.
Traven, S. A., Reeves, R. A., Slone, H. S., & Walton, Z. J. (2019). Frailty Predicts Medical Complications, Length of Stay, Readmission, and Mortality in Revision Hip and Knee Arthroplasty. The Journal of Arthroplasty, 34(7), 1412-1416. https://doi.org/10.1016/j.arth.2019.02.060
Traven SA, et al. Frailty Predicts Medical Complications, Length of Stay, Readmission, and Mortality in Revision Hip and Knee Arthroplasty. J Arthroplasty. 2019;34(7):1412-1416. PubMed PMID: 30930155.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frailty Predicts Medical Complications, Length of Stay, Readmission, and Mortality in Revision Hip and Knee Arthroplasty. AU - Traven,Sophia A, AU - Reeves,Russell A, AU - Slone,Harris S, AU - Walton,Zeke J, Y1 - 2019/03/07/ PY - 2018/12/17/received PY - 2019/02/13/revised PY - 2019/02/27/accepted PY - 2019/4/2/pubmed PY - 2019/4/2/medline PY - 2019/4/2/entrez KW - complications KW - frailty KW - morbidity KW - revision hip arthroplasty KW - revision knee arthroplasty SP - 1412 EP - 1416 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 34 IS - 7 N2 - BACKGROUND: The purpose of this study is to evaluate the 5-factor modified frailty index (mFI-5) as a predictor of postoperative complications, readmission, and mortality in patients undergoing revision hip and knee arthroplasty. METHODS: A retrospective analysis of the American College of Surgeon's National Surgical Quality Improvement Program's database for patients undergoing revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) between the years 2005 and 2016 was conducted. The 5-factor score, which includes presence of comorbid diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status, was calculated for each patient. Multivariate logistic regression models were used to assess the relationship between the mFI-5 and postoperative complications while controlling for demographic variables. RESULTS: In total, 13,948 patients undergoing rTHA and 16,304 patients undergoing rTKA were identified. The mFI-5 was a strong predictor of serious medical complications (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement), discharge to a facility, total length of stay, readmission, and mortality (P ≤ .007). CONCLUSION: The mFI-5 predicts serious medical complications, increased length of stay, discharge to a facility, hospital readmission, and mortality in patients undergoing rTHA and rTKA. All the variables within the mFI-5 are easily obtained through the patient history, allowing for a practical clinical tool that hospitals and physicians can use to identify at-risk patients, educate and engage patients and their families in a shared decision-making conversation, and guide perioperative care in order to optimize patient outcomes. LEVEL OF EVIDENCE: III. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/30930155/Frailty_Predicts_Medical_Complications_Length_of_Stay_Readmission_and_Mortality_in_Revision_Hip_and_Knee_Arthroplasty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(19)30216-5 DB - PRIME DP - Unbound Medicine ER -
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